Health inspection·May 23, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that physicians orders were followed for two of 17 residents reviewed (Residents 7, 28). Residents Affected - Few Findings include: An annual Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 7, dated April 12, 2024, revealed that the resident was cognitively intact, was independent for personal care needs, had a colostomy (an opening for the colon, or large intestine, through the stomach) and had diagnosis that included acute kidney failure. Physician's orders for Resident 7, dated April 29, 2024, included an order for the resident to have her periostomy (skin around the ostomy site) wound cleansed with wound cleanser, pat dry, betamethasone cream and calcium alginate applied to the wound bed, and covered with a bordered gauze every evening and as needed. A skin and wound note for Resident 7, dated May 20, 2024, at 8:27 a.m., revealed that the resident's wound treatment orders had changed. Physician's orders for Resident 7, dated May 20, 2024, included for the resident to have her periostomy wound cleansed with wound cleanser then collagen applied and covered with a bordered gauze every evening shift and as needed. A nurse's note, dated May 20, 2024, at 4:22 p.m., revealed that the resident was seen by the wound consultant and new orders were received and carried out. Review of the Medication Administration Record (MAR) for Resident 7, dated May 2024, revealed that on May 20, 21 and 22, 2024, both above-mentioned wound care orders were active and documented as administered. Interview with the Director of Nursing on May 23, 2024, at 12:48 p.m. confirmed that a new order was obtained for wound care on May 20, 2024, and was administered; however, the previous order was not discontinued as it should have been. Both treatment orders were documented as administered on the dates identified above; however, the order, dated April 29, 2024, should have been discontinued and not administered. The facility's policy on Hypoglycemia (Low blood sugar), dated February 12, 2024, revealed that insulin was to be held when a resident's blood sugar was less than 60 milligrams per deciliter (mg/dL) (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 395891 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)